title: Home blood pressure measurement in elderly patients with cognitive impairment: comparison of agreement between relative-measured blood pressure and automated blood pressure measurement.
abstract: OBJECTIVE
  Home blood pressure measurement (HBPM) is recommended by guidelines for hypertension management. However, this method might be difficult to use in elderly individuals with cognitive disorders. Our aim was to assess the agreement and the feasibility of HBPM by a relative as compared with 24-h ambulatory blood pressure monitoring (ABPM) in elderly patients with dementia.
  
  
  METHODS
  Sixty outpatients with dementia aged 75 years and older with office hypertension (≥140/90 mmHg) were subjected successively to HBPM by a trained relative and 24-h ABPM. The order of the two methods was randomized. Current guidelines' thresholds for the diagnosis of hypertension were used.
  
  
  RESULTS
  The mean (SD) age of the patients was 80.8 (6.1) years (55% women) and the mean (SD) mini-mental state examination score was 20.1 (6.9). The feasibility of relative-HBPM was very high, with a 97% success rate (defined by ≥12/18 measurements reported). The blood pressure measurements were highly correlated between the two methods (r=0.75 and 0.64 for systolic blood pressure and diastolic blood pressure, respectively; P<0.001 for both). The agreement between the methods for the diagnosis of sustained hypertension and white-coat hypertension was excellent (overall agreement, 92%; κ coefficient, 0.81; 95% CI, 0.61-0.93). Similar results were found for daytime-ABPM.
  
  
  CONCLUSIONS
  In cognitively impaired elderly patients, HBPM by a relative using an automated device was a good alternative to 24-h ABPM.
authors.affiliation: Department of Gerontology II, Assistance Publique - Hôpitaux de Paris, Broca Hospital, Paris, France. matthieu.plichart@inserm.fr
authors.forename: Matthieu
authors.initials: M
authors.lastname: Plichart
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Seux
authors.forename: Laure
authors.initials: L
authors.lastname: Caillard
authors.forename: Edouard
authors.initials: E
authors.lastname: Chaussade
authors.forename: Jean-Sébastien
authors.initials: JS
authors.lastname: Vidal
authors.forename: Clémence
authors.initials: C
authors.lastname: Boully
authors.forename: Olivier
authors.initials: O
authors.lastname: Hanon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001795:Blood Pressure Determination; D018660:Blood Pressure Monitoring, Ambulatory; D003704:Dementia / Q000150:complications*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis*; D008297:Male; D012648:Self Care / Q000295:instrumentation*; D059466:White Coat Hypertension / Q000150:complications / Q000175:diagnosis*